Herpes simplex virus

There are two strains of the herpes simplex virus (HSV) in humans: HSV-1 and HSV-2. Whilst it was previously thought HSV-1 accounted for oral lesions (cold sores) and HSV-2 for genital herpes it is now known there is considerable overlap

Features

• primary infection: may present with a severe gingivostomatitis
• cold sores
• painful genital ulceration

Management

• gingivostomatitis: oral aciclovir, chlorhexidine mouthwash
• cold sores: topical aciclovir although the evidence base for this is modest
• genital herpes: oral aciclovir. Some patients with frequent exacerbations may benefit from longer term aciclovir

Pregnancy

• elective caesarean section at term is advised if a primary attack of herpes occurs during pregnancy at greater than 28 weeks gestation
• women with recurrent herpes who are pregnant should be treated with suppressive therapy and be advised that the risk of transmission to their baby is low

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